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HHS Officials Explain $47.9B in Improper Medicare Payments

John Commins, for HealthLeaders Media, July 29, 2011

Overall, Medicare paid $516 billion in 2010 for medical services for 47 million Americans, according to government estimates.

Michelle Snyder, deputy COO at the Centers for Medicare & Medicaid Services, told the subcommittee that "like other large and complex Federal programs, Medicare is susceptible to payment, billing, and coding errors."

"It is important to clarify what these billing anomalies are – and are not," she said in prepared remarks.

Snyder said circumstances that lead to billing and coding errors can result from:

  • Services with insufficient documentation,
  • Provided services that are not determined to bereasonable and necessary
  • Incorrectly coded claims
  • Services with no documentation

"Further, improper payments do not mean an item or service was not needed. These payments are not necessarily fraudulent; rather, they tend to be an indication of errors made by the provider in filing a claim or inappropriately billing for a service," Snyder told the committee.  

Kay L. Daly, director of Financial Management and Assurance at the Government Accountability Office told the subcommittee that the estimate for improper payments was "incomplete" because it has yet to provide an improper payment estimate for Medicare prescription drug payments, which totaled $59 billion in fiscal year 2010.

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1 comments on "HHS Officials Explain $47.9B in Improper Medicare Payments"


Dawn Smith (8/8/2011 at 12:26 PM)
Just graduating from a medical office specialist course, I had the opportunity to have classes that included patient billing and we briefly learned about billing and coding. Can I just say what a mess that system is! I cannot believe how many codes there are and having to [INVALID] them on a yearly basis. It's a wonder that there are so many mistakes. And why in these departments aren't questions being asked if one's not sure of how to bill a patient? There's got to be someone held accountable for such mistakes. It is out of control and ridiculous. Let's slow down a bit people and take the time to do the job right the first time!!!! Where's the support in these departments? Something's got to change and change like yesterday! Start cracking the whip supervisor's!!! The problem with some people is that they are there to punch in and punch out. There is no compassion for what they do in there jobs. There is no one there to stand up and call someone out on their poor behavior. Having people's treatments be eligible or not, to some can mean financial disaster. We are all trusting in our clinics/hospitals to have competent people do their jobs correctly so we don't have to worry about our visit(s). Lets take pride in our positions and if you can't, then get out of the business!